Health-care bill passes first legislative hurdle

By Cherry Sokoloski
North Forty News

A health-care reform bill co-sponsored by Rep. John Kefalas, D-Fort Collins, passed its first hurdle in mid-March when it was approved by the House Business Affairs and Labor Committee in a 5-to-4 vote. House Bill 1273 calls for designing a system of universal health care for Colorado citizens.

The Colorado Guaranteed Health Care Act will go to the House Appropriations Committee on April 3. If it receives the go-ahead there, a House vote could come the following week.

HB 1273 would create a Colorado Health Care Authority, charged with working out the details of a comprehensive health-care system for the state. The authority would be governed by a 23-member board of directors including health-care professionals, consumers and representatives from business and the health insurance industry.

The health-care system would be primarily publicly funded. Health-care providers would be private, and consumers would be able to choose their providers.

This type of system is generally called "single-payer" because there would be one public insurer rather than the current system of multiple private insurers. The Kefalas bill has been endorsed by 58 organizations including health-care professionals such as the Colorado Nurses Association and the Colorado Medical Society. Other endorsers include the Colorado Education Association, the League of Women Voters, Progressive Democrats of Colorado, the Colorado AFL-CIO and Republicans for Single Payer.

"Clearly the present system is not working," Kefalas said, adding that support for considering single-payer as an option has been growing in the state.

"I think if we do it right it will work," he said. "It will provide choice, with lower cost and better outcomes." He thinks if Colorado adopts a single-payer plan, it could be a model for the rest of the nation.

Before a single-payer system could be put into place, several things would have to happen. First, HB 1273 would have to pass the House and Senate. Second, Kefalas and others would have to raise about $1.4 million in private money to finance the work of the Colorado Health Care Authority. Third, the state legislature, perhaps in 2011, would be asked to approve legislation setting up the new single-payer system. And finally, voters would have to approve any new taxes involved in funding the system.

About 800,000 Coloradans were uninsured in 2007, and Kefalas suspects the numbers are higher now. The negative economic impact of the high number of uninsured was estimated at $3.9 billion in 2007 in Colorado alone, he said.

Furthermore, Kefalas pointed out, health insurance premiums overall have increased 100 percent since 2000. A family of four now pays an average of $12,000 per year in health insurance premiums, he stated.

The driving force behind his proposal, Kefalas said, is to "reduce these costs dramatically and get healthier people."

Opposition surfaces

Kefalas said his bill is opposed by the private health insurance industry, since private companies would be replaced by a single, state-run insurance entity. Some resistance has also come from the business sector, Kefalas said, although he believes he shares a lot of common ground with the business community.

"I have to break through some of the stereotypes," he said.

Kefalas noted that he welcomes debate on the single-payer issue, but there has been "a lot of emotional rhetoric that's not based on the facts."

Gov. Bill Ritter came out in opposition to HB 1273, mostly because his administration believes the authority's work would duplicate that done by Colorado's 208 Commission in 2007. That commission, which looked at several health-care models, found that a single-payer model was the most cost-efficient and the only one that covered everyone. However, the commission did not endorse a single-payer system for Colorado.

Kefalas argued that the authority's work would build on that of the 208 Commission but would "dig deeper" into the single-payer model, answering some questions not answered by the previous study. For example, it would look at how to obtain waivers and exemptions from the federal government regarding Medicare and Medicaid funds.

Four principles touted

Kefalas has identified four principles that he considers important in a health-care system. The most important, he said, is providing guaranteed access to health care, or universal coverage. He also wants to reduce costs, improve outcomes and make health care affordable for families and businesses.

Kefalas also wants health-care coverage to be portable. Under his plan, he said, "Health insurance would not be tied to one's employment."

The system envisioned by Kefalas would give special attention to primary and preventive care. It would encourage each citizen to choose a "medical home" for providing that primary care and coordinating all other care.

Kefalas said he has been studying health-care reform models for some time, with this question in mind: "What is the most cost-efficient model that can provide health-care coverage to everyone in Colorado?" He decided that the single-payer model provided the best answer to that question.

Funding studied

HB 1273 would require the Health Care Authority to investigate a fair and equitable way to finance the new health-care system. Some of the funding could come from existing sources, such as the medical portions of workers' compensation insurance, car insurance and state liability insurance. Part of the financing would likely come from a payroll tax on both employers and employees.

Kefalas said the new system, as envisioned, would provide comprehensive care for all citizens. Benefits would include inpatient and outpatient care, dental and eye care, physical and occupational therapy, mental health and substance abuse treatment, prescription drugs, hearing services, long-term care and chiropractic services.

And, Kefalas emphasized, the cost of such comprehensive care would be considerably less than Coloradans' current health-care costs.

"The goal is to save people money," he stated.

Several factors would contribute to lower costs, including a large pool of insured people, lower administrative costs, a central purchasing authority and annual negotiations for reimbursement of providers.

Other elements of the proposed health-care system include a statewide system of electronic medical records, public education in wellness and end-of-life issues and a transition plan to help those whose jobs are impacted by the change.

State vs. federal

In the health-care reform debate, many people have asked whether states or the federal government should come up with a solution. According to Kefalas, "We have to push from both levels."

He acknowledged that with the Obama administration in charge, there's serious commitment on the federal level to health-care reform. "But, you know how things are in Washington," he said. "We can't afford to wait."

Kefalas also said that federal officials are paying attention to what's going on in Colorado regarding health-care reform.